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Approaches to Remyelination Therapies in Multiple Sclerosis
AbstractPurpose of reviewWhile there are a growing number of therapies targeting relapse prevention in multiple sclerosis (MS), there are no approved therapies promoting remyelination. Understanding endogenous myelin formation, remyelination strategies, pre-clinical models, and clinical outcomes is essential to the interpretation of current and future clinical trials of remyelinating agents.Recent findingsSeveral recent clinical trials of remyelination therapies, including opicinumab, clemastine, and GSK239512, showed negative or modest results. These results could highlight challenges translating pre-clinical studies into...
Source: Current Treatment Options in Neurology - June 27, 2019 Category: Neurology Source Type: research

Understanding Atrial Cardiopathy: an Under-Recognized Contributor to Cardioembolic Stroke
AbstractPurpose of reviewIschemic stroke is the fifth leading cause of death in the world with cardioembolic stroke (CES) causing a disproportional amount of the morbidity and mortality associated with stroke. Atrial fibrillation (AF) is the leading cause of CES, and as the population ages, the incidence of CES is anticipated to rise. The importance of proper diagnosis and treatment of patients with embolic-appearing stroke is significant due to the burden of disease and the severity of the illness.Recent findingsThe past decade has seen an explosion of treatment options for patients with CES related to AF as well as bette...
Source: Current Treatment Options in Neurology - June 24, 2019 Category: Neurology Source Type: research

Treatment of Post-Stroke Depression
We present the reader with the most recent evidence to support pharmacological, psychosocial, and neuromodulation interventions in PSD. We also discuss the relevance of using antidepressants and psychotherapy to prevent PSD and discuss evidence that antidepressant treatment may reduce mortality after stroke.Recent findingsNeuroinflammation and decrease neurogenesis and plasticity may play an important role in the mechanism of PSD. The strongest predictors of PSD are stroke severity, early physical disability, and severity of loss of functioning. Nevertheless, populations at risk for PSD are yet to be identified. Recent met...
Source: Current Treatment Options in Neurology - June 24, 2019 Category: Neurology Source Type: research

Treatment Options for Agitation in Dementia
AbstractPurpose of reviewThe goal of the current review is to provide an update on the management of agitation in persons with dementia with a focus on pharmacological management of persons with Alzheimer ’s disease.Recent findingsAs consistently effective and safe pharmacologic interventions are still lacking, identifying and addressing medical and environmental precipitants remain a priority. Acetylcholinesterase inhibitors and memantine should be initiated to enhance cognition, and if present, management of insomnia or sundowning with trazodone is indicated. If agitation persists, treatment with citalopram can be init...
Source: Current Treatment Options in Neurology - June 23, 2019 Category: Neurology Source Type: research

Sleep Disorders and Stroke: Does Treatment of Obstructive Sleep Apnea Decrease Risk of Ischemic Stroke?
AbstractPurpose of reviewThis review aims to support obstructive sleep apnea (OSA) as a risk factor for ischemic stroke, review treatment strategies for OSA, provide a comprehensive review of clinical data on OSA treatment and ischemic stroke risk, and to critically assess if treatment of OSA decreases the risk of ischemic stroke and if treatment improves outcomes and subsequent ischemic stroke risk in post-stroke patients.Recent findingsSeveral observational studies, randomized controlled trials (RCTs), and meta-analyses have examined the risk of ischemic stroke and cardiovascular events in patients with OSA and have also...
Source: Current Treatment Options in Neurology - June 23, 2019 Category: Neurology Source Type: research

Immune-Mediated Neuropathies
AbstractPurpose of reviewThe purpose of this review article is to discuss the pathogenesis of acute and chronic immune-mediated neuropathies along with the recent advances in their treatment.Recent findingsSince the first description of Guillain-Barre syndrome (GBS) more than a century ago, there have been numerous forms of immune-mediated neuropathies described expanding the spectrum. Understanding the role of the immune system in the pathogenesis of immune-mediated neuropathies has been an advancement towards the diagnosis and treatment.SummaryIt is postulated that immune-mediated neuropathies are a group of diseases res...
Source: Current Treatment Options in Neurology - June 20, 2019 Category: Neurology Source Type: research

Prevention and Treatment of Acute Stroke in the Nonagenarians and Beyond: Medical and Ethical Issues
AbstractPurpose of reviewAs one of the fastest growing portions of the population, nonagenarians will constitute a significant percentage of the stroke patient population in the near future. Nonagenarians are nevertheless not specifically targeted by most clinical guidelines. In this review, we aimed to summarise the available evidence guiding stroke prevention and treatment in this age group.Recent findingsSeveral recent observational studies have shown that the benefits of anticoagulation for the oldest old patients with atrial fibrillation may outweigh the bleeding risk. A sub-analysis of the IST-3 trial has shown for t...
Source: Current Treatment Options in Neurology - May 7, 2019 Category: Neurology Source Type: research

Lipoic Acid and Other Antioxidants as Therapies for Multiple Sclerosis
AbstractOxidative stress (OS), when oxidative forces outweigh endogenous and nutritional antioxidant defenses, contributes to the pathophysiology of multiple sclerosis (MS). Evidence of OS is found during acute relapses, in active inflammatory lesions, and in chronic, longstanding plaques. OS results in both ongoing inflammation and neurodegeneration. Antioxidant therapies are a rational strategy for people with MS with all phenotypes and disease durations.Purpose of reviewTo understand the function of OS in health and disease, to examine the contributions of OS to MS pathophysiology, and to review current evidence for the...
Source: Current Treatment Options in Neurology - May 5, 2019 Category: Neurology Source Type: research

Current Treatment Options in Neurology —SMA Therapeutics
AbstractPurpose of reviewIn this review, we discuss the clinical and genetic features of 5q spinal muscular atrophy and highlight approved and upcoming therapies.Recent findingsWe emphasize that multidisciplinary care has been a key component of the improved quality and length of life seen in these individuals in the past decade. We discuss the evidence leading to the approval of nusinersen and the evidence leading to the anticipated approval of onasemnogene abeparvovec-xioi. Additional clinical therapies that are on the horizon are discussed and the importance of continued multidisciplinary care even after treatment is em...
Source: Current Treatment Options in Neurology - April 28, 2019 Category: Neurology Source Type: research

Brachial Plexopathies: Update on Treatment
AbstractPurpose of reviewBrachial plexopathies (BPs) are a heterogeneous group of diseases which can profoundly affect person ’s function and quality of life. This review targets current approaches to treatment of different BP types.Recent findingsAlthough there are multiple BP etiologies, non-traumatic causes are particularly unrecognized by clinicians, leading to misdiagnoses and delay in appropriate therapies. Recent data suggests that idiopathic neuralgic amyotrophy may be 50-fold more common than previously thought, with poorer outcomes than reported unless rapid diagnosis is followed by a multidisciplinary approach...
Source: Current Treatment Options in Neurology - April 26, 2019 Category: Neurology Source Type: research

Impulse Control Disorders in REM Sleep Behavior Disorder
AbstractPurpose of reviewThis paper reviews clinical and pathophysiological features of both impulse control disorders (ICDs) and REM sleep behavior disorder (RBD) in Parkinson ’s disease (PD), as well as current evidences of their association. Then, we suggest recommendations to manage PD patients with RBD in order to prevent this potentially devastating psychiatric complication.Recent findingsICDs are psychiatric complications occurring in patients with Parkinson ’s disease (PD) treated with dopaminergic replacement therapies (DRT). Besides DRT, risk factors for ICDs are poorly known. We recently showed an associatio...
Source: Current Treatment Options in Neurology - April 7, 2019 Category: Neurology Source Type: research

Statins in Ischemic Stroke Prevention: What Have We Learned in the Post-SPARCL (The Stroke Prevention by Aggressive Reduction in Cholesterol Levels) Decade?
We describe the current status of lipid-lowering therapies for ischemic stroke prevention. The SPARCL trial published in 2006 has been a landmark study in vascular neurology. The trial demonstrated that high-dose atorvastatin prevents recurrent stroke, and led the AHA/ASA to recommend statin therapy for patients with stroke or TIA of atherosclerotic origin.Recent findingsRecently, the J-STARS study demonstrated that therapy with low-dose pravastatin reduced atherothrombotic infarction incidence among patients with prior ischemic stroke. Besides, several trials have shown improved stroke outcomes with non-statin lipid-lower...
Source: Current Treatment Options in Neurology - April 7, 2019 Category: Neurology Source Type: research

OnabotulinumtoxinA in Migraine and Other Headaches: Review and Update
AbstractPurpose of the reviewThe role of onabotulinumtoxinA in headache management was serendipitously found over a decade ago and approved for chronic migraine in 2010 based on pivotal studies. The purpose of this review is to highlight the impact on headache and other health parameters which is critically reviewed, as well as the putative mechanisms of action.Recent findingsOnabotulinumtoxinA is effective in migraine, not only headache frequency and pain intensity but also other health parameters including quality of life. Tolerability is high and benefit/cost analysis is favorable. It should be considered off-label in r...
Source: Current Treatment Options in Neurology - April 3, 2019 Category: Neurology Source Type: research

Beta-Blockers for Migraine Prevention: a Review Article
AbstractPurpose of reviewThis review seeks to establish the role of beta-blockers (B-adrenergic receptor antagonists) in the pathophysiology of migraine prophylaxis, compare the efficacy of this group of medications with other common prophylactic agents, and also explore the relative benefits of using individual beta-blockers compared with others.Recent findingsNew evidence supports beta-blockers having several mechanisms of action in migraine prophylaxis. Numerous trials reveal significant clinical differences between various beta-blockers in migraine prophylaxis and that commonly used doses of beta-blockers are not optim...
Source: Current Treatment Options in Neurology - March 22, 2019 Category: Neurology Source Type: research

Antidepressants for Preventive Treatment of Migraine
AbstractPurpose of reviewThis review describes the pharmacology of each antidepressant class as it applies to migraine prevention, summarizes the evidence base for each medication, and describes relevant side effects and clinical considerations. Use of antidepressants for migraine prevention in clinical practice is also discussed.Recent findingsAntidepressants are commonly used as migraine preventives. Amitriptyline has the best evidence for use in migraine prevention. Nortriptyline is an alternative in patients who may not tolerate amitriptyline. The sedating effect of TCAs can be beneficial for patients with comorbid ins...
Source: Current Treatment Options in Neurology - March 20, 2019 Category: Neurology Source Type: research